No abstract

Abstract:Background & Aims: The role of high resolution esophageal impedance manometry (HRIM) for establishing risk for dysphagia after anti-reflux surgery is unclear. We conducted a prospective study of children with primary GER disease, for whom symptoms of dysphagia to solids were determined pre-and post-operatively and we examined for features that may predict post-operative dysphagia. Methods: Thirteen children (aged 6.8 -15.5 years) undergoing work up prior to 360o Nissen fundoplication were included. A dysphagia score assessed symptoms. A HRIM procedure recorded 5ml liquid, 5ml viscous and 2cm solid boluses. We assessed esophageal motility, esophago-gastric junction (EGJ) morphology, EGJ contractility and pressure-flow variables indicative of bolus distension pressures and bolus clearance pressures. A composite pressure-flow-index score (PFI) was also derived. Results: Pre-operative PFI was positively correlated with post-operative dysphagia score (PFI viscous bolus r = 0.771, p<0.005 Abbreviations: HRIM, high resolution impedance manometry; GER, gastroesophageal reflux; EGJ, esophago-gastric junction; LES, lower esophageal sphincter; CD, crural diaphragm; TZ, transition zone; CDP, contractile deceleration point; pH-MII, pH with multichannel intraluminal impedance; PPI, proton pump inhibitor; EPT, esophageal pressure topography; IRP4s, 4s integrated relaxation pressure; CFV, contractile front velocity; DCI, distal contractile integral; DL, distal latency; EGJ-CI, EGJ contractile index; DPA, distension pressure during bolus accommodation; DPCT, distension pressure during compartmentalized transport; DPE, distension pressure during esophageal emptying; PFI, pressure-flow-index; IR, impedance ratio; SDL, swallow to distension latency; DCL, distension to contraction latency; RP, ramp pressure; IEM, ineffective esophageal motility; EoE, eosinophilic esophagitis. Acknowledgements:We thank Mrs G Seiboth, Mrs K Lowe and Ms S Kritas for assistance with performance of HRIM studies and Dr Junko Fujino for assistance with reviewing endoscopy images. • The ability to accurately predict post-operative dysphagia risk is of interest to gastroenterologists. 'Pressure-flow' anomalies may be predictors of dysphagia symptoms following anti-reflux surgery.• Past studies were performed using 'low-resolution' perfusion lower esophageal sphincter sleeve-manometry.2. What are the significant and/or new findings of this study?• Dysphagia symptoms were common in our pediatric GER disease patients who were receiving diagnostic work up for anti-reflux surgery.• Of all parameters evaluated, bolus 'clearing pressures' were most reliably associated with dysphagia symptoms. Results: Pre-operative pressure-flow index was positively correlated with post-operative dysphagia score (viscous bolus r = 0.771, p<0.005). Of three variables that comprise the pressure-flow index, the ramp pressure measured during bolus clearance was the main driver of the effect seen (viscous bolus r = 0.819, p<0.005). Conclusions:In order to mitigate symptoms i...

No abstract

Background and Aim The prevalence and incidence of eosinophilic esophagitis (EoE) has been increasing over recent years. However, the natural history remains incompletely understood particularly the differences in disease characteristics and progression of childhood‐onset and adult‐onset EoE. The aim of this study was to evaluate the disease characteristics and progression of childhood‐onset and adult‐onset EoE. Methods A cross‐sectional, questionnaire‐based study, on 87 adults and 67 children from 2 major tertiary hospitals in South Australia was conducted. Data of those who were diagnosed with EoE between 1999 and 2018 were collected and correlated with medical records. Results Of the 87 adults with EoE, 34 (39%) were diagnosed at the age of < 18 years (childhood‐onset EoE). Reflux symptoms were more common in childhood‐onset EoE, whereas asthma was more common in adult‐onset EoE. The median duration of symptoms prior to diagnosis of EoE was > 1–4 years in childhood‐onset disease (44%) and ≥ 10 years in adult‐onset disease (34%). Food impaction was significantly more common on initial presentation in those with adult‐onset EoE, whereas weight loss was more common in childhood‐onset EoE. At the time of questionnaire, regurgitation, abdominal pain, and bloating were more common in childhood‐onset EoE. Those with childhood‐onset EoE were more likely to have multiple symptoms at questionnaire when compared with their adult‐onset counterparts. In both groups, 15% (5/34 childhood‐onset EoE and 8/53 adult‐onset EoE) were asymptomatic at the time of questionnaire. Conclusion Childhood‐onset EoE appears to be a progressive disease from childhood to adulthood, however with more inflammatory‐type symptoms post transition compared to those with adult‐onset EoE.

It was found that 1.7% of cases met the locally agreed standard (from best available evidence) that haematology requests, including full blood count and coagulation screen, should only be undertaken in those with disclosed high alcohol intake and positive bleeding history. A consistent bleeding history and alcohol intake should always be documented thoroughly.